TY - JOUR
T1 - Effectiveness of second-look endoscopy after gastric endoscopic submucosal dissection in patients taking antithrombotic agents
T2 - a multicenter propensity score matching analysis
AU - Iwatsubo, Taro
AU - Takeuchi, Toshihisa
AU - Hakoda, Akitoshi
AU - Fujiwara, Yasuhiro
AU - Nagami, Yasuaki
AU - Naito, Yuji
AU - Dohi, Osamu
AU - Tatsuta, Tetsuya
AU - Sawaya, Manabu
AU - Jin, Xiaoyi
AU - Koike, Tomoyuki
AU - Sugimoto, Mitsushige
AU - Murata, Masaki
AU - Hamada, Kenta
AU - Okada, Hiroyuki
AU - Kobara, Hideki
AU - Chiyo, Taiga
AU - Yoshida, Norimasa
AU - Tomatsuri, Naoya
AU - Inaba, Tomoki
AU - Ishikawa, Shigenao
AU - Nagahara, Akihito
AU - Ueyama, Hiroya
AU - Koizumi, Eriko
AU - Iwakiri, Katsuhiko
AU - Mizukami, Kazuhiro
AU - Murakami, Kazunari
AU - Furuta, Takahisa
AU - Suzuki, Takahiro
AU - Ogasawara, Naotaka
AU - Kasugai, Kunio
AU - Isomoto, Hajime
AU - Kawaguchi, Koichiro
AU - Shibagaki, Kotaro
AU - Kataoka, Hiromi
AU - Shimura, Takaya
AU - Suzuki, Hidekazu
AU - Nishizawa, Toshihiro
AU - Higuchi, Kazuhide
N1 - Funding Information:
Osamu Dohi and Tomoyuki Koike have received a collaboration research grant from Fujifilm Corporation. The remaining authors declare no conflict of interest. A funding source had no role in the design or analysis of this study as no funding sources were utilized.
Publisher Copyright:
© 2022, The Author(s) under exclusive licence to The International Gastric Cancer Association and The Japanese Gastric Cancer Association.
PY - 2022
Y1 - 2022
N2 - Background: The risk of bleeding after gastric endoscopic submucosal dissection (ESD) in antithrombotic agent users has increased, and its management remains a problem. Second-look endoscopy (SLE) following gastric ESD in antithrombotic agent users may be effective in preventing delayed bleeding, but this requires elucidation. Therefore, this study aimed to investigate the efficacy of SLE in reducing bleeding after gastric ESD in patients receiving antithrombotic agents. Methods: This retrospective cohort study was conducted at 19 referral hospitals in Japan. A total of 1,245 patients who were receiving antithrombotic agents underwent gastric ESD between January 2013 and July 2018. The incidence of delayed bleeding was compared between SLE and non-SLE groups using propensity score matching analysis. Results: Overall, 858 patients (SLE group, 657 patients; non-SLE group, 201 patients) were analyzed. After matching, 198 pairs were created. Delayed bleeding occurred in 10 patients (5.1%) in the SLE group and 16 patients (8.1%) in the non-SLE group [odds ratio (OR) 0.605, 95% confidence interval (CI) 0.23–1.46, p = 0.310]. In the subgroup analysis, SLE reduced the incidence of delayed bleeding in patients receiving heparin bridging therapy (6.3% and 40.0%, respectively; p = 0.004). In the SLE group, prophylactic coagulation did not significantly reduce delayed bleeding compared to the no treatment group (14.6% and 8.6%, respectively; p = 0.140). Conclusions: SLE was ineffective in reducing bleeding after gastric ESD in antithrombotic agent users, overall. A prospective comparative study is warranted to definitively evaluate the effectiveness of SLE in reducing bleeding in high-risk patients.
AB - Background: The risk of bleeding after gastric endoscopic submucosal dissection (ESD) in antithrombotic agent users has increased, and its management remains a problem. Second-look endoscopy (SLE) following gastric ESD in antithrombotic agent users may be effective in preventing delayed bleeding, but this requires elucidation. Therefore, this study aimed to investigate the efficacy of SLE in reducing bleeding after gastric ESD in patients receiving antithrombotic agents. Methods: This retrospective cohort study was conducted at 19 referral hospitals in Japan. A total of 1,245 patients who were receiving antithrombotic agents underwent gastric ESD between January 2013 and July 2018. The incidence of delayed bleeding was compared between SLE and non-SLE groups using propensity score matching analysis. Results: Overall, 858 patients (SLE group, 657 patients; non-SLE group, 201 patients) were analyzed. After matching, 198 pairs were created. Delayed bleeding occurred in 10 patients (5.1%) in the SLE group and 16 patients (8.1%) in the non-SLE group [odds ratio (OR) 0.605, 95% confidence interval (CI) 0.23–1.46, p = 0.310]. In the subgroup analysis, SLE reduced the incidence of delayed bleeding in patients receiving heparin bridging therapy (6.3% and 40.0%, respectively; p = 0.004). In the SLE group, prophylactic coagulation did not significantly reduce delayed bleeding compared to the no treatment group (14.6% and 8.6%, respectively; p = 0.140). Conclusions: SLE was ineffective in reducing bleeding after gastric ESD in antithrombotic agent users, overall. A prospective comparative study is warranted to definitively evaluate the effectiveness of SLE in reducing bleeding in high-risk patients.
KW - Antithrombotic drug
KW - Bleeding
KW - Endoscopic submucosal dissection
KW - Retrospective cohort
KW - Second-look endoscopy
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U2 - 10.1007/s10120-022-01303-y
DO - 10.1007/s10120-022-01303-y
M3 - Article
C2 - 35622240
AN - SCOPUS:85130719904
JO - Gastric Cancer
JF - Gastric Cancer
SN - 1436-3291
ER -